The Insurance Regulatory and Development Authority (IRDA) is an independent regulatory body, which protects the policyholder’s interests. They supervise the growth and speed of the insurance sector in India. They supervise the growth and speed of the insurance sector in India. In 1999, the IRDA was established in accordance with the IRDA Act, and was entrusted with various functions. On Thursday, the Finance Minister Nirmala Sitharaman requested S C Khunthia, IRDAI President, to ‘act immediately’, in order to address the denial of insurance company’s cashless complaints. She also stated that the insurance companies have resolved more than 9 lakhs of COVID claims for Rs 8,642 crore. “Some hospitals that deny cashless insurance are receiving reports. IRDAI Shri SC Khuntia was called upon to act promptly to the President. Covid has been included in the complete health insurance scheme on March 20. Networked or even temporary hospitals are available cashless, ” the minister said. She added that insurance companies have been asked to give preference to COVID claims settlement by the Insurance Regulatory Development Authority of India (IRDAI). Moreover, she stated, “As of 20/4/21, the insurance companies have resolved over 9 lakh Covid-related claims for Rs 8,642 crore. There may also be tele-consultations. In order to priority permits and settlements of Covid cases, IRDAI will send companies.”
India is reporting over 3.14 lakh of new coronavirus cases per day, the highest ever single-day count in any country, which amounts to 1,59,30,965 in total COVID-19 cases. Under the data updated from the Union Health Ministry on Thursday, there were 3,14,835 fresh infections in 24 hours, while the death rate increased to 1,84,657, with a further 2,104 deaths. The number of active cases increased steadily to 22,91,428, representing 14.38% of the total infection for the 43rd day in a row. Recognizing that some hospitals do not grant cashless treatment facilities for Covid-19, despite policies being entitled to cashless treatments according to their policies, the IRDAI states that where insurers have a cashless treatment arrangement, such network hospitals are obliged to provide all treatments with cashless treatment.
“All the service level agreements (SLAs) signed with the general insurers and health insurers of the network (hospitals) are obligated to provide the policyholders including Covid-19 in accordance with agreed SLA provisions and terms and conditions of a policy contract with cashless facilities for any treatment,” it stated. There is, therefore no benefit to the insurance company / TPA from the cashless treatment, any policyholders who are entitled to the cashless facility of all network providers (hospital), with whom an agreement is reached. Any of these enlisted network providers (hospitals) deny cashless facilities, the aggrieved policyholders may file a complaint with the insurance company in question.
It also directed insurance companies to ensure smooth access to cash-free facilities by actively interacting with the clinics for all network operators (hospitals).
